Program Letter of Agreement

Program Letter of Agreement

between

University of FloridaCollege of Medicine Department of INSERT NAME

for itsINSERT NAME Program

and

INSERT NAME OF EXTERNAL INSTITUTION

This document serves as a Letter of Agreement between the University of Florida College of Medicine Department of INSERT NAME(UF COM), for its Training Program and INSERT NAME OF EXTERNAL INSTITUTION

This Letter of Agreement is effectiveINSERT DATE, and will remain in full force and effect for five years, or until updated, changed or terminated by the UF COM – INSERT NAMETRAINING Program.

1. Persons Responsible for Education and Supervision of residents participating in the INSERT NAME OF TRAINING Program:

At University of FloridaCollege of Medicine: INSERT NAME, MD, Program Director

AtINSERT NAME OF EXTERNAL INSTITUTION:INSERT NAME OF SUPERVISING PHYSICIAN, MD

2. The individual listed above willprovide appropriate supervision of residents in patient care activities and maintain a learning environment conducive to educating the residents in each of the Accreditation Council for Graduate Medical Education (ACGME)competency areas. The site director and sitefaculty evaluate resident performance in a timely manner during each rotation / educationalassignment and document this evaluation at the completion ofthe rotation / assignment as defined by the residency program’s goals and objectivesand evaluationprocess.

3. The content of the educational experiences has been developed according to ACGME Residency Program Requirements, and include the following goals and objectives:

As specified on the attached.

In cooperation, INSERT NAME, MD,Training Program Director,and the site director are each responsible for the day-to-day activities ofthe residents and they ensure that the outlined goals and objectives are metduring the course of the educational experiences at INSERT NAME OF EXTERNAL INSTITUTION.

The duration of the rotations / assignments to INSERT NAME OFEXTERNAL INSTITUTIONare defined in the goals and objectives and yearlyrotation schedules.

1. Policies and Procedures that Govern Resident Education

Residents will be required to comply with the TrainingProgram’s Policies and the University of Florida’s Graduate Medical Education Committee’s Policies and applicable policies ofINSERT NAME OF EXTERNAL INSTITUTION.

______

INSERT NAME, MD

Program Director

INSERT NAME Program

______

INSERT NAME, MD

SITE DIRECTOR

INSERT NAME OF EXTERNAL INSTITUTION

______

Lisa Dixon, MD

Designated Institutional Official

Associate Dean Graduate Medical Education

Chair Graduate Medical Education Committee